The Canada Health Act Is a Cruel Deception, Not Best in the World

The Canadian health care system is under enormous stress. It has been studied, task forced, blue ribbon paneled, and royal commissioned to death. Despite substantial evidence that exposes the diminishing quality of care and access in Canada's health care system, our political leaders have appeared powerless to act. Yet, the responsibility rests squarely with them and Canadians are paying a colossal price for their unrelenting paralysis.

It will come as a surprise to many Canadians that as a percentage of GDP, we have the second most expensive health care system in the world. Meanwhile, in terms of the only real metric that matters -- health outcomes -- we rank far from the top. So you'd think that federal and provincial policy makers would be fixated on only one question: What do we need to do to have a system that delivers the highest quality health care in the most productive and cost effective fashion?

Well they're not. Ottawa is washing its hands of any meaningful national role and the provinces are doing what they do best: complaining that they aren't getting the attention and money they need from Ottawa. And so it goes.

The Organization for Economic Cooperation and Development (OECD) ranks Canada sixth highest out of 34 OECD countries on total health spending per capita and as a percentage of GDP. Despite that we rank among the lowest as far as the value we receive for the amount of money we spend. Canadians pay more out-of-pocket than citizens of many other countries with national health care coverage. Canada has a lower number of doctors and nurses, beds, critical diagnostic equipment per capita than the OECD average.

The costs of services not covered by government have typically risen faster than those that are publicly funded. We pay far more out of our own pockets for health care, ranking sixth on this measure at $636 U.S. per capita for 2009, up one position from a year earlier. Public funding pays for only 46 per cent of prescription drug spending, and only seven per cent of the services of other professionals such as dentists and those providing routine vision care. Some Canadians are forgoing services they need but can't afford. In a 2010 international survey, 10 per cent of the Canadian respondents said that they had not filled a prescription or had skipped doses because of cost issues.

In 2009, the Canadian Medical Association (CMA) issued a discussion paper called "Toward a Blueprint for Health Care Transformation." We learned that the Euro-Canada Health Consumer Index has ranked Canada 30th out of 30 countries in terms of value for money spent on health care in both 2008 and 2009. In a damning and indictment of appalling policy and political paralysis at the federal and provincial levels, the CMA has said: "Unfortunately, almost half a century later, the vision that led to Medicare has been lost in a fog of political posturing. System reforms have only tinkered at the margins to the point that many Canadians have come to believe that lengthy medical wait times are a fact of life and a price to pay to protect the principle of universal health care."

The Conference Board reported that Canada's healthcare system was forecast to consume 11.9 per cent of GDP and costs poised to increase further. The increase is mainly driven by the rising prevalence of chronic diseases and demand for health services, new technologies, and health human resources. They estimated that Canada's economy was only 64 per cent of the growth of health care costs and the recession has dramatically increased this mismatch.

Moreover, Canadians who are now 60 years of age can expect to see health care consume almost 15 per cent of GDP -- in contrast to the 2008 share of 10.8 per cent -- when they turn 75. This is a very troubling trend line, particularly in light of a low growth economy. The Conference Board cites more worrying data: The health of Canada's population is "less than optimal" compared to other OECD countries. Canadians will also be surprised to learn that we have the third highest rate of mortality due to diabetes, and the second highest rate of infant mortality.

The Canada Health Act (CHA) says that wherever we live within this vast country of ours, citizens are entitled to timely and quality access to health care. The reality is a lot different.

Medicare and the CHA have reached mythical proportions in Canada. It is an untouchable "sacred trust." Those that dare question it -- much less talk of reform -- are virtually branded enemies of the state. I experienced this first hand last year when as a candidate in the general election I had the temerity to point out a simple fact: Canada does not have the "best healthcare system in the world," as all politicians have told us for years. In fact, that is a cruel deception. And CHA is nothing more than a hollow and toothless statement of intention and principles, has been the most untouchable of scared cows of Canadian politics since 1984. All three national parties kneel at its altar.

The CHA is federal legislation passed in 1984 describing how provincial and territorial governments must conform to specific terms for them to receive federal transfer funding. In reality and practice, the CHA's conditions are voluntary, and enforcement is haphazard, at best. Canada has 14 health care systems, not one. Contrary to the popular perception amongst a great many people, we do not have a truly national health care system.

The 1984 Canada Health Act is a well-meaning law that has proven to be a significant obstacle to serious reform of our health care system and has no teeth. Many people think government has to fund a wide range of services. In fact, the CHA requires only Medicare -- that is, medically necessary services provided by physicians and hospitals -- to be paid fully by government. Over the years, as the cost of these elements has grown, the provinces have put in place a rigid system of prohibitions and rationing -- yes, rationing -- of services to try to manage demand.

It is clear that what has been glaringly absent from the national health care equation is not smart people, good and sensible ideas, or the desire of the public for better service. What's missing is political will and leadership.

Stephen Harper's Conservatives and the NDP of Thomas Mulcair offer their worn-out and divisive creed, ideology, and bumper stickers. Harper and Mulcair have boxed themselves into their respective and traditional corners. This is hardly conducive to the constructive leadership and open engagement this serious issue so desperately calls for. Yet, they've chosen to vacate and to abdicate on a pressing question that literally and directly touches the lives of every single resident of this country. In a very real sense, there is no more important issue than our health and well being.

Medicare is under crippling stress made worse through the neglect of the Harper government. And what there is of a "national" health care system is fractured, expensive, inefficient, and mired in special interests, bureaucracy, and ideological quagmire. It is in dire need of leadership to infuse it with national cohesion, fairness, and cost effectiveness. The system must be reformed and modernized for the 21st century. The Conservatives and New Democrats can't and won't do it.

At the very least, the owners of the health care system, the people of Canada, deserve facts and an informed discussion. As the campaign begins to choose a new leader of the Liberal Party of Canada, the time is right to lay the sacred cows and political correctness to rest. Let us have that discussion. The national interest demands that the Liberal Party accept the responsibility of leading a conversation, which no one else has, that is so vital to Canada's future prosperity and security.